ucsf osher center for integrative medicine mini medical...
TRANSCRIPT
UCSF Osher Center for Integrative Medicine
Mini Medical School for the Public
FALL 2013 – Thursday Course Series PRECISION MEDICINE: MAKING THE PERSONAL POSSIBLE
Date: Thursday, November 7, 2013, 7:00 pm – 8:45 pm Topic: PRIVACY, SECURITY, REGULATION AND VOLUNTARY DATA SHARING Speakers: Claire D. Brindis, DrPH Director, Philip R. Lee Institute for Health Policy Studies at UCSF; Professor, Department of Pediatrics and Health Policy, UCSF Dan Dohan, PhD, Associate Professor, Health Policy and Social Medicine, UCSF Mini Kahlon, PhD, Deputy Director and Chief Information Officer, UCSF Clinical & Translational Science Institute
Claire D. Brindis, Dr. P.H., is Professor of Pediatrics and Health Policy, Department of Pediatrics and the Department of Obstetrics, Gynecology and Reproductive Health Sciences at the University of California, San Francisco. She is the Director of the Philip R. Lee Institute for Health Policy Studies and the Bixby Center for Global Reproductive Health at UCSF. Dr. Brindis’ research interests include the intersections between population health and precision and personalized medicine, health disparities, consumer engagement in regulatory and health policy issues emerging from precision medicine, tracking the implementation of the Accountable Care Act, and strategies for closing the gap between the emergence of evidence-based innovation and its timely application to policy and programs.
Dan Dohan, PhD is a sociologist by training and currently is Professor of health policy and social medicine at the Philip R. Lee Institute for Health Policy Studies. Dan is also Associate Director for Training and Development at the Institute. Dan is interested in medicine as a cultural system. His research examines how medicine relates to science and discovery. He is interested in how new medical technologies can reduce social inequality. And he is interested in how we train health professionals and how we could do it better. He is involved in a number of NIH-funded research studies in these areas. One he will discuss today is EngageUC, a UC-wide effort to improve how the University of California conducts biorepository research.
UCSF Osher Center for Integrative Medicine
Mini Medical School for the Public
Maninder (Mini) Kahlon is the Deputy Director, Chief Information Officer (CIO) and a Board member of UCSF’s Clinical & Translational Science Institute (CTSI). CTSI facilitates the rapid translation of research to improvements in patient and community health. Established in 2006, the Institute was among the first and largest of the now 60-member, National Institutes of Health (NIH)-funded, Clinical and Translational Science Awards (CTSA) consortium.
At CTSI Mini is responsible for the institutes programs and strategy, coordinating across UCSF and the national network. As CIO she facilitates the development of technology and informatics projects that are necessary to accelerate research, ranging from new ways to enable the discovery of expertise and facilitate networking to driving cross-institutional collaboration to share clinical data for research across the UC medical centers.
A neuroscientist trained at UCSF and faculty in the Department of Neurology, she also brings experience from working in the software industry in Silicon Valley and the philanthropic non-profit sector. Mini has spoken in a wide variety of contexts, ranging from describing the cognitive science of unconscious processing to Kaiser doctors, catalyzing social change through technology at SXSW Interactive, and the creation of national networks of research expertise at the NIH. She has been profiled in the press, including Business Week, San Francisco Chronicle and the Oakland Tribune for her work in leveraging science to create societal impact.
11/7/2013
1
Setting the stage: Privacy, security, regulation, and
voluntary data sharing within Precision Medicine
UCSF Mini-Medical SchoolNovember 7, 2013
Claire D. Brindis, Dr. P.H.Director, Philip R. Lee Institute
for Health Policy StudiesProfessor, Pediatrics and
Health Policy
Precision Medicine and Personalized Medicine
Genome
Metabolome
Microbiome
Environment
Epidemiology
Patient Medical Record (experience, behavior, etc.)
Proteome
Building a layered knowledge network: Interlayer connections established by multidisciplinary teams
•
UCSF Precision Medicine Platform
11/7/2013
2
UCSF Precision Medicine Platform
Regulatory
Privacy
Data Sharing
Security
Consumer Engagement
Ability to Integrate practices and policies across three planesAbility to Integrate practices and policies across three planes
Biomedical continuum:Build seamless links between basic discovery, translation, clinical care, patients, citizens
Biomedical continuum:Build seamless links between basic discovery, translation, clinical care, patients, citizens
Transdisciplinary science:Merge physics/chemistry/engineering/Computation theory, concepts, methods into biomedical research
Transdisciplinary science:Merge physics/chemistry/engineering/Computation theory, concepts, methods into biomedical research
Stakeholder synergy:Cooperate across .edu, .com, .org and .gov sectors and others Stakeholders
Stakeholder synergy:Cooperate across .edu, .com, .org and .gov sectors and others Stakeholders
7
EMRs, diagnostic images Claims, revenue cycle
Clinical trials, genomics Purchasing patterns, social media
Geo-environmental, weather patterns, etc.
Table of Contents
11/7/2013
3
变
Chinese Symbol for Change
变
Danger and Opportunity
From here to tomorrow: The Promise of Precision Medicine
What system infrastructure will be necessary?
What health care systems will need to be in place to provide precision and personalized medicine?
Along the continuum of health and illness, how could precision medicine be integrated?
What will it take to create such a system?
11/7/2013
4
Challenges in Implementation ofPrecision Medicine
1.
1. Capacity to interpret genomic sequence data?
What genetic variants are ready for “translation with impact” on sufficiently large proportion of population?
Derive new insights from complex and large data sets.
Challenges in Implementation ofPrecision Medicine
2. “$1,000 genome” -- Sequencing an individual’s or a tumor’s entire genome can occur relatively inexpensively and can be offered as part of clinical care.
Downstream interpretation will likely add significant costs (at least in the short term).
Challenges in Implementation ofPrecision Medicine
3. Are technological advances outpacing our ability to use information effectively?
4. Are we as a society ready to make these types of investments? Disparities?
Challenges in Implementation ofPrecision Medicine
5. Regulatory issues - Examples
FDA Drug Approval
Linking data from patient care with data from research.
Precision Medicine needs to have identifiable data vs. basic and translational research use de-identified or unidentifiable data.
Institutional Review Board requirements
11/7/2013
5
Challenges in Implementation ofPrecision Medicine
6. Determining Coverage and Reimbursement –
-- Molecular testing codes
-- Reimbursement concerns for patients
-- Unclear value for payers
Challenges in Implementation ofPrecision Medicine
7. Patient Confidentiality and Consent
Learning From the Past…..Challenges in Implementation of
Precision Medicine
8. System Capacity
• Maintaining confidentiality and protection of data
• Standardized risk assessment tools
• Integration of family health history into EMR
• Develop capabilities (consent, interpretation, counseling) for solving diagnostic dilemmas
• Developing clinical decision support tools for pharmacogenomics and diagnostic tests
11/7/2013
6
Challenges in Implementation ofPrecision Medicine
8. System Capacity (more….
• Develop the policy agenda to support PPM
• Assess genomic medicine literacy of patients and providers
• Education for the next generation of providers and health care workforce
• Active engagement of patients and their families
Challenges in Implementation of Precision Medicine –9. Intersection with Population Health?
Value
In the meantime…. Forecasting
11/7/2013
7
Prediction is always difficult, especially about the future
Niels Bohr
Ginsburg GS and Willard HGenomic and Personalized Medicine. Academic Press: 2012.
Time
Cos
t
Baseline Risk
Preclinical Progression
Clinical Diseaseand Progression
Dis
ease
Bur
den
TreatmentPrognosisDiagnosisSusceptibility Screening
The Opportunity for Genome Informed Medical Care
Personal data value chain
LabelLabelLabel DisseminationProcessing and analysisStorageData CollectionEstablish
Compatibility
The individual
• Storage protections may be different
• Storage location could be in different sovereign states
• Storage period can vary from original intent
• Personal data could be collected from the individual in either a passive or active manner
• Collection of data may be transferred to multiple stakeholders
• Purpose of analysis could change from originally stated purpose
* Intent of analysis and degree of anonymization) could change
• Dissemination could include transfer to different entities or types of entities
• Levels of protection and protection capacity can vary between parties
• Different purpose/use/ level of analysis
Questions in establishing a personal data value chain
LabelLabelLabel
• Who is the collecting party?
• What type of entity are they?
• What is the purpose for which they are collecting data?
• What type and format is the data?
• Where is the data being stored?
• What policies are in place in the storage location
• For how long?
• What are the protection methods (including technical and organizational?
• How is the data being processed?
• At what level of analysis?
• In combination with what other data sets?
• For what purpose?
• For whose benefit?
• Who is the data being shared with?
• Is it a different organization or entity?
• For what purpose?
• In what location?
• What security mechanisms govern the transfer?
DisseminationProcessing and analysisStorageCollection
Establish Compatibility
Illustrative question set
The individual